The Department of Community Health (DCH)
The department was established in early 2013. It acts as a bridge between the hospital and the community at large and works in various community related activities. These include public health education, sensitization & diseases investigations especially among the most at-risk populations, operational research on TB and building community awareness on clinical trials.
TB among Miners
Among the populations with high risk and burden of tuberculosis (TB) are the small scale miners (SSM). KIDH serves a significant number of SSM from Mirerani mines. This area is relatively densely populated located in Simanjiro District – Manyara region in the North – Eastern Tanzania. The Mirerani mines (where the famous and precious gemstone i.e. Tanzanite is being mined) are located about 30minutes drive from the Mirerani town. The mines are notorious for the huge number of SSM. Usually SSM spend an underground 12 hours shift per day where the general working environment is generally poor. At certain times ones’ shift may extend well more than 12hours. The famous local tanzanite market (where brokers advertise and sell the gemstone) is located at Mererani town. The market is characterized by compactly arranged small and dark, highly congested rooms where gemstone business is being conducted on a daily basis.
Department of Community Health (DCH) of KIDH conducted the first phase of active TB investigation among SSM in Mererani. A total of 602 clients were investigated, of whom 40 were found to have TB (26 based on AFB smear microscopy and 14 based on chest X-ray findings). This is equivalent to a prevalence of 6.6% that is well above that in the general population, showing miners in Mererani are a very high-risk group for TB.
In April/May 2014, DCH conducted a second phase of TB investigation in the same population in which 224 clients were investigated, 5 were confirmed to have TB (based on GeneXpert evaluation) and 22 (9.8%) had abnormal radiological chest X-ray findings consistent with pneumoconiosis, TB or post-TB complications hence put under follow up evaluation. This is equivalent to a prevalence of 2.2%. Though this was low than what was found from the previous investigation phase, but still it shows that the miners in Mererani are a very high-risk group for TB and hence more sustainable intervention should be put in place.
The DCH has been continuously conducting education and sensitization campaigns to the miners and also the mines’ managers so as to improve TB case detection and improve the miners’ working environments, especially to cut-off dust exposure.
These activities have been supported by the LHL International – Norway.
Operational Research on Tuberculosis
Conducting operational research is among the key components for improving the quality of service provision. The DCH has been part of this and is currently implementing an operational research to determine the magnitude of both TB/MDRTB disease and infection among relative/contacts of patients with MDRTB who were treated (and currently admitted) at KIDH. The research is done in collaboration with the National Institute for Medical Research (NIMR) under the financial support from the East African Public Health Laboratory Networking Project (EAPHLNP). Areas covered are six regions of Kilimanjaro, Arusha, Tanga, Manyara, Pwani and Dar es Salaam. The information gathered will help to fine-tune measures to control TB, especially by targeting areas and means of finding the TB patients at an early stage and ensure they are properly treated.
Community Awareness on Clinical Trials
Among the key areas on fighting TB is to find novel drugs for treatment of TB, which are more user friendly in terms of treatment duration, number of pills and also having tablets/syrup alternatives of current injectable medications. The world is taking efforts on finding new medications and KIDH has been part of these efforts as being among the key recruitment centers in already completed and some ongoing clinical trials. Among the crucial parts of clinical trials is effectively engaging the communities in clinical trials.
For the past five years the DCH has been organizing and conducting community engagement (CE) activities aiming at building community awareness on TB prevention and control, finding new drugs for TB & clinical trials and in particular the right participants in clinical trials. Currently these activities covers the whole region of Kilimanjaro but the intention is to extend the activities all over the country.
The CE activities are done in collaboration with the Kilimanjaro Clinical Research Institute (KCRI) and the Community Advisory Board (CAB) for Siha District and are mostly funded by The TB Alliance. The CAB comprises of members from different professional background, including teachers, priests, police personnel, village leaders, etc.